Ventral Hernia Repairs: 10 year Single Institution Review at Thomas Jefferson University Hospital

Abstract Background Definitive repair of recurrent ventral hernias using abdominal wall reconstruction techniques is an essential tool in the armentarium for general and plastic surgeons. Ramirez 1 et al describes the “component separation” technique to mobilize the rectus-abdominus internal oblique and external oblique flap to correct the defect. The recurrence rate of incisional hernias increases to 20% after gastric bypass or extensive weight loss.2 The incidence of ventral hernias after failed recurrent hernia repair increases to 40%.3 It has been reported that utilizing the sliding myofascial flap repair technique, the recurrence rate was reduced to 8.5%.4 Materials and Methods This retrospective institutional study reviews 10 years of myofascial flap reconstruction 1996-2006 at TJUH. Several techniques and prosthetic materials (alloderm, permacol, vicryl, composix) were used in our institutional review by multiple surgeons in this time period. Our goal is to identify risk factors (i.e. smoking, diabetes, obesity, size of defect, peripheral vascular disease, enterocutaneous fistula, infection) that predict or categorize patients that are at increased risk for failure of primary repair, measure the complication rates (i.e. infection, recurrence, seroma, hematoma) and evaluate the techniques and long term effectiveness of several prosthetic materials. Results Three thousand twenty ventral hernia repairs were performed at TJUH between 1996 and 2006. Two thousand three hundred eighty three approximated the rectus abdominus primarily and of these 645 utilized a component separation technique. The recurrence rate for component separations was 18.5% and 83% for primary repairs. The average follow up was 5.49 years. Statistically significant risk factors (p\u3c0.05) for recurrence were obesity (BMI\u3e30 kg/m2), age\u3e65 years, male gender, preoperative infection and postoperative seroma. Conclusion Myofascial flaps are a safe, reliable therapy for recurrent ventral hernias that addresses the population of patients that have failed conventional primary closure and reduce the recurrence rates greater than 40 percent to 18.5 percent in the carefully selected patient population

Patellofemoral pain syndrome (PFPS): a systematic review of anatomy and potential risk factors

Patellofemoral Pain Syndrome (PFPS), a common cause of anterior knee pain, is successfully treated in over 2/3 of patients through rehabilitation protocols designed to reduce pain and return function to the individual. Applying preventive medicine strategies, the majority of cases of PFPS may be avoided if a pre-diagnosis can be made by clinician or certified athletic trainer testing the current researched potential risk factors during a Preparticipation Screening Evaluation (PPSE). We provide a detailed and comprehensive review of the soft tissue, arterial system, and innervation to the patellofemoral joint in order to supply the clinician with the knowledge required to assess the anatomy and make recommendations to patients identified as potentially at risk. The purpose of this article is to review knee anatomy and the literature regarding potential risk factors associated with patellofemoral pain syndrome and prehabilitation strategies. A comprehensive review of knee anatomy will present the relationships of arterial collateralization, innervations, and soft tissue alignment to the possible multifactoral mechanism involved in PFPS, while attempting to advocate future use of different treatments aimed at non-soft tissue causes of PFPS

Treatment of American tegumentary leishmaniasis in special populations : a summary of evidence

We aimed to assess and synthesize the information available in the literature regarding the treatment of American tegumentary leishmaniasis in special populations. We searched MEDLINE (via PubMed), EMBASE, LILACS, SciELO, Scopus, Cochrane Library and mRCT databases to identify clinical trials and observational studies that assessed the pharmacological treatment of the following groups of patients: pregnant women, nursing mothers, children, the elderly, individuals with chronic diseases and individuals with suppressed immune systems. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. The available evidence suggests that the treatments of choice for each population or disease entity are as follows: nursing mothers and children (meglumine antimoniate or pentamidine), patients with renal disease (amphotericin B or miltefosine), patients with heart disease (amphotericin B, miltefosine or pentamidine), immunosuppressed patients (liposomal amphotericin), the elderly (meglumine antimoniate), pregnant women (amphotericin B) and patients with liver disease (no evidence available). The quality of evidence is low or very low for all groups. Accurate controlled studies are required to fill in the gaps in evidence for treatment in special populations. Post-marketing surveillance programs could also collect relevant information to guide treatment decision-making

Osteoid Osteoma of the Trapezium: Case Report of an Unusual Tumor Location Presenting a Diagnostic Challenge

Osteoid osteoma is a benign bone tumor, which represents approximately 10% of all benign bone tumors. When localized to the carpus, osteoid osteomas are most often seen in the scaphoid and capitate. Rarely, these tumors can also be observed in the trapezium. Given the infrequency with which osteomas are located in the trapezium and often nonspecific presenting symptoms, diagnosis of this tumor can be challenging and requires a high index of suspicion